The RPS (2021) generic Prescribing Competency Framework forms the basis of the curriculum and has been used to inform the design and delivery of the programme acting as a contextual framework to structure learning and assessment for all students regardless of their professional background.
THE CONSULTATION (COMPETENCIES 1-6)
1: ASSESS THE PATIENT
Undertakes an appropriate clinical assessment, including a medical, social and medication history including allergies and intolerances and refers to or seeks guidance from another member of the team, a specialist or a prescribing information source when necessary.
Accesses and interprets all available and relevant patient records including relevant investigations necessary to inform treatment options by systematically considering a working or final diagnosis. Understands the condition(s) being treated, their natural progression and how to assess their severity, deterioration and anticipated response to treatment including adherence to and effectiveness of current medicines.
2: CONSIDER THE OPTIONS
Considers both non-pharmacological (including no treatment) and pharmacological approaches to modifying disease and promoting health, including pharmacological treatment options such as optimising doses as well as stopping treatment (appropriate polypharmacy, de-prescribing). Assessing the risks and benefits to the patient/service user of taking or not taking a medicine or treatment. Applies understanding of the mode of action and pharmacokinetics of medicines and how these may be altered taking into account any relevant patient factors and the potential impact on route of administration and formulation of medicines.
Identifies, accesses, and uses reliable and validated sources of information and critically evaluates other information. Stays up-to-date in own area of practice and applies the principles of evidence-based practice, including clinical and cost-effectiveness, taking into account the wider perspective including the public health issues related to medicines and their use and promoting health and understanding of antimicrobial resistance and the roles of infection prevention, control.
3: REACH A SHARED DECISION
Works with the patient/carer in partnership to make informed choices, agreeing a plan that respects patient preferences including their right to refuse or limit treatment, identifying and respects the patient/service user in relation to diversity, values, beliefs and expectations about their health and treatment with medicines.
Routinely assesses adherence in a non-judgemental way and understands the different reasons non-adherence can occur and how best to support patients/carers. Building a relationship which encourages appropriate prescribing which explores the patient/service users/ carers understanding of a consultation and aims for a satisfactory outcome for the patient/carer and prescriber.
4: PRESCRIBE
Prescribes a medicine with up-to-date awareness of its actions, indications, dose, contraindications, interactions, cautions, and unwanted effects. Understands the potential for adverse effects and takes steps to avoid/minimise, recognise and manage them. Prescribes within relevant frameworks for medicines use as appropriate. Prescribes generic medicines where practical and safe for the patient and knows when medicines should be prescribed by branded product.
Understands and applies relevant national frameworks for medicines use to own prescribing practice. Accurately completes and routinely checks calculations relevant to prescribing and practical dosing. Considers the potential for misuse of medicines, Uses up-to-date information about prescribed medicines. Only prescribes medicines that are unlicensed, ‘off-label’, or outside standard practice if satisfied that an alternative licensed medicine would not meet the patient’s clinical needs.
Electronically generates or writes legible unambiguous and complete prescriptions and contemporaneous records and clinical notes of prescribing decisions. Communicates information about medicines and what they are being used for when sharing or transferring prescribing responsibilities/ information.
5: PROVIDE INFORMATION
Checks the patient/service user/carer’s understanding of and commitment to the patient’s management, monitoring and follow-up giving clear and accessible information about their medicines, and how to identify reliable sources of information about their medicines and treatments.
Ensures that the patient/service user/carer knows what to do if there are any concerns about the management of their condition, if the condition deteriorates or if there is no improvement in a specific time frame and where possible, encourages and supports patients/service users/carers to take responsibility for their medicines and self-manage their conditions.
6: MONITOR AND REVIEW
Establishes and maintains a plan for reviewing the patient’s/service user treatment, ensuring that the effectiveness of treatment and potential unwanted effects are monitored. Detects and reports suspected adverse drug reactions using appropriate reporting systems, adapting management plans in response to on-going monitoring and review of the patient’s/service users condition and preferences.
PRESCRIBING GOVERNANCE (COMPETENCIES 7-10)
7: PRESCRIBE SAFELY
Prescribes within own scope of practice, recognising any limitations of own knowledge and skill including common types and causes of medication errors and how to prevent, avoid and detect them. Identifies the potential risks associated with prescribing via remote technology taking steps to minimise risk to support safe prescribing. Reporting prescribing errors, near misses and critical incidents, reviewing practice to prevent recurrence.
8: PRESCRIBE PROFESSIONALLY
Maintains confidence and competence to prescribe, accepting accountability and responsibility for prescribing, understanding legal and ethical implications including regulatory frameworks.
Makes prescribing decisions based on the needs of patients, recognising and dealing with factors that might unduly influence prescribing by working within the NHS/organisational/regulatory and other codes of conduct when interacting with the pharmaceutical industry.
9: IMPROVE PRESCRIBING PRACTICE
Reflects on own and others prescribing practice, and acts upon feedback and discussion, including colleagues’ inappropriate or unsafe prescribing practice using appropriate mechanisms. Understands and uses available tools to improve prescribing.
10: PRESCRIBE AS PART OF A TEAM
Acts as part of a multidisciplinary team to ensure that continuity of care across care settings is developed and not compromised, establishing relationships with other professionals based on understanding, trust and respect. Negotiates the appropriate level of support and supervision for role as a prescriber and provides support and advice to other prescribers or those involved in administration of medicines.
The aim of this module is to enable the autonomous professional to attain the competencies as identified by the Royal Pharmaceutical Society (2021) Framework for safe effective prescribing practice.
